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| A brief approach to runner's foot pain |
Runners' foot pain can manifest in two ways. It can happen unexpectedly, such as when you trip over your ankle or experience a severe pain while jogging — these are known as acute injuries. They can also develop gradually over time, and the etiology of these injuries is frequently unclear. In this post, I'll discuss the second type of foot injury: those that appear to occur for no apparent reason. I'll also give the Top Three treatments for each of these foot issues that I've found to be the most effective.
On the outside of the foot, there is a lot of pain.
Sinus tarsi syndrome is a condition that affects the feet.
This illness is more painful than hazardous, despite its big name. Chronic inflammation of the delicate lining of the ankle joint causes it.
The pain is commonly felt right in front of the lateral malleolus (ankle bone), in a location that is very similar to where your ankle ligaments run, and it is sometimes misdiagnosed as a ligament sprain.
Causes:
After you've sprained your ankle, it's common for it to develop. Ankle ligaments typically recover in 8 to 12 weeks, however if your pain lasts longer than that, sinus tarsi syndrome could be to cause.
Another common cause is if you walk or run with your foot rolling in excessively (over-pronation). You tend to crush the outside of the ankle joint when this happens, which might cause it to flare up. Muscle weakness around the ankle or hips, wearing too soft trainers, or running on a camber are just a few of the causes that can cause your foot to roll in excessively.
My top 3 recommendations are as follows:
The primary goal of treatment is to improve the posture of the foot and prevent it from rolling in excessively during walking or running. This can be accomplished by:
- ALL DAY LONG, I WAS WEARING SUPPORTIVE SHOES. This injury may have been caused by jogging, but you'll need to take care of it throughout the day if you want it to heal.
- In most cases, I also recommend supportive insoles to my patients (see examples below). They may benefit from wearing an ankle brace for 4 to 6 weeks while we strengthen the muscles in extreme situations. The goal here is to prevent the foot from rolling in.
- To avoid this from happening again, you should do foot arch strengthening exercises as well as strengthening the stability muscles around your hips.
Tendinopathy of the Peroneal Tendon
The peroneal muscles run the length of your lower leg on the outside. Their primary purpose is to help you turn your foot out. The tendons on the outside of your ankle wrap around the back of the bone. If these guys are to fault for your foot pain, you'll notice it on the outside of your foot, either below the ankle bone or at the outside border.
Causes:
The most common cause of this type of injury is something that causes your foot to slide out more while running (excessive supination).
- Is it time to retire your old running shoes and invest in a new pair?
- How tense are your calf muscles? Your peroneal muscles will be put under extra strain if your calves (particularly the soleus) are tight.
- Have you been jogging on cambers that caused your foot to roll out more than usual? Change your running path to one that is flat.
In the interior of the foot, there is a lot of pain.
Tendinopathy of the Tibialis Posterior
One of the key muscles that supports your arch and prevents your foot from rolling in or pronating excessively is the Tibialis Posterior (Tib Post). Tib Post tendinopathy is a condition that produces pain on the inside of the heel and the inside of the arch of the foot. The Tib Post's muscular belly is located in your calf, and it can cause pain along the inside of your shin bone.
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| Tendinopathy of the Tibialis Posterior |
Causes:
In runners, the main cause of Tib Post tendinopathy is excessive foot rolling in during running (over-pronates). Over-pronation can be caused by a variety of factors, including wearing the wrong running shoes, doing a lot of downhill running, having weak muscles around the ankle or higher up in the leg, and so on.
My top 3 recommendations are as follows:
- Examine your running shoes (are you seeing a pattern here?). – Is it because they're overly soft or because they're worn out? Do they offer enough assistance?
- To relieve part of the tension on the Tib Post tendons, use supportive insoles or orthotics.
- Muscles in your foot and ankle, as well as the stability muscles around your hips, should be strengthened.
Ankle pain on the front side
Anterior tibialis tendinopathy
This tendon wraps around the inside of the foot and travels along the front of the ankle joint. It extends your foot upward while simultaneously preventing it from rolling in too far. If this tendon is causing discomfort in your foot, it usually manifests itself in the place where your foot meets your ankle.
Causes:
In my practice, the most common cause of Tib Ant tendinopathy is when runners tie their laces too tight, causing the tendon to rub while they run. Running in much heavy shoes or performing a lot of downhill running might also make the Tib Ant flare up.
The top 3 fixes are:
- Examine your shoelaces to see whether they're a problem. To aid your tendon's recovery, you may need to knot them exceedingly loosely. I triggered mine when hiking in Scotland a few months ago, and it took about 4 weeks of careful management to bring it back to normal.
- If you've recently switched running shoes, make sure they're not the source of the problem.
- If you run on flatter terrain for a bit, see if it helps.
You have a pain under your heel.
Plantar Fasciitis
Plantar Fasciitis is a condition that affects the soles of the feet.
I've published an entire series of blog posts about how to deal with this annoying problem in the past, but here are the highlights. From your heel to your toes, the plantar fascia is a thick fibrous band of tissue. Its primary purpose is to support the arch of your foot and prevent it from collapsing when you put weight on it. Plantar fasciitis is an overuse injury that occurs when the plantar fascia, which connects the foot to the heel bone, is strained. It can be excruciatingly uncomfortable, preventing you from running or walking.
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| Plantar Fasciitis |
Causes:
Anything that causes additional strain on the plantar fascia, such as wearing unsupportive shoes, gaining weight, or drastically increasing your jogging distance or intensity. I've previously discussed the causes of plantar fasciitis in greater depth.
My top 3 recommendations are as follows:
- ALWAYS WEAR SUPPORTIVE SHOES WITH ARCH SUPPORT INSERTS. You may have sustained this injury while running, but if you want to recover quickly, you'll need to nurture it all day.
- Determine what's causing the problem and strive to avoid it.
- Do not return to running too quickly. Before returning to running, you should have at least four weeks of pain-free time and be able to walk 10 kilometers without discomfort (and without pain the next day).
Pain in the front of your foot
Metatarsalgia
This is pain under the ball of your foot. My patients often also describe it as feeling as if they are walking on a pebble. It is caused by inflammation in the little joints where your toes attaches to your foot.
Causes:
When these tiny joints are subjected to excessive pressure for an extended period of time, they become uncomfortable and sore. The biggest cause of this ailment, in my experience (unless you're a dancer), is wearing the improper shoes. I'm not just talking about running shoes here. The culprits are frequently regular work or leisure shoes. Ballet pumps, men's dress shoes, minimalist running shoes, and outdated trainers are all examples.
My top 3 recommendations are as follows:
- Until your foot has fully recovered, switch to wearing soft trainers ALL DAY. This could mean that you'll have to travel in them as well.
- You may need to switch to more cushioned shoes if you're jogging in minimalist shoes (with very thin soles). Minimalist shoes are frequently promoted as the key to injury avoidance, yet they can also induce injuries, such as metatarsalgia and metatarsal stress fractures.
- The use of orthotics with a metatarsal dome (as seen in the pictures below) can often ease some of the pressure on these troublesome joints. It sits immediately behind the metatarsal heads and raises the little joints just a little.
Morton's neuroma
Morton's neuroma is a type of neuroma that affects the brain.
In your forefoot, there are little nerves that run between the bones. When these nerves are compressed, they swell and become inflamed, causing discomfort in the forefoot that commonly extends into the toes. You may have tingling or numbness as a result of the inflamed nerves.
Causes
Morton's neuroma is commonly caused by wearing shoes that are overly tight. However, anything that causes the bones to move and crush together excessively, such as having very flexible feet or rolling your feet excessively while running, can contribute (pronation or supination).
My top 3 recommendations are as follows:
- Make sure you don't wear any shoes that are too tight.
- Wear shoes that are supportive and don't allow you to move about too much.
- Use insoles with a metatarsal dome to assist distribute the forefoot's little bones and give the nerves a little more room.
- Here are some examples of arch support and metatarsal lift orthotics. What I appreciate about them is that they appear to have domes that can be adjusted. Remember that the dome must be positioned behind, not on, your foot's ball.
Are you experiencing tingling in your ankle or foot?
Tingling, numbness, a pins-and-needles sensation, or any other unusual sensations are usually signs of a nerve injury. Injuries to the lower back, leg, or foot/ankle can induce tingling and other symptoms in the ankle and feet. If you're having these kinds of problems, I'd recommend seeing a physiotherapist or another sports medicine practitioner. They aren't always more serious injuries, but they might be difficult to recover from on your own.
Fractures caused by stress
Stress fractures are uncommon, but they are a danger for everyone who runs frequently. The navicular bone, calcaneus, and 5th metatarsal are the most prevalent locations where runners get stress fractures.
Bones usually produce a stress reaction first, during which they are extremely painful but unbroken. It's possible to recover from this ailment in as little as 4 to 6 weeks if you discover it early and take the appropriate steps. If you ignore the signs and symptoms and keep training, it might turn into a full-blown fracture that takes months to recover.
Causes:
High exercise loads are frequently accompanied with insufficient recuperation time and, in some cases, a restricted diet. Stress fractures are difficult to diagnose because they don't always show up on conventional x-rays. This should be diagnosed by an experienced sports physiotherapist.
My top 3 recommendations are as follows:
- Remove any aggravating activities and rest the affected body part from all impact. This might entail putting it in a boot for a few weeks.
- Examine your training plan, including your food and recovery, to see where you went wrong.
- Request that your general bone density and vitamin D levels be checked by your doctor.
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